Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

Victor D. Plat, Anne Kasteleijn, Jan Willem M. Greve, Misha D. P. Luyer, Suzanne S. Gisbertz, Ahmet Demirkiran, Freek Daams

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20 Citations (Scopus)


Purpose: The number of bariatric procedures has increased exponentially over the last 20 years. On the background of ever-increasing incidence of esophageal malignancies, the altered anatomy after bariatric surgery poses challenges in treatment of these cancers. In this study, an epidemiological estimate is presented for the future magnitude of this problem and treatment options are described in a retrospective multicenter cohort. Methods: The number of bariatric procedures, esophageal cancer incidence, and mortality rates of the general population were used for epidemiological estimates. A retrospective multicenter cohort was composed; patients were treated in three large oncological centers with a high upper gastrointestinal cancer caseload. Consecutive patients with preceding bariatric surgery who developed esophageal cancer between 2014 and 2019 were included. Results: Approximately 3200 out of 6.4 million post bariatric surgery patients are estimated to have developed esophageal cancer between 1998 and 2018 worldwide. In a multicenter cohort, 15 patients with esophageal cancer or Barrett’s esophagus and preceding bariatric surgery were identified. The majority of patients had a history of Roux-en-Y gastric bypass (46.7%) and had an adenocarcinoma of the distal esophagus (60%). Seven patients received curative surgical treatment, five of whom are still alive at last follow-up (median follow-up 2 years, no loss to follow-up). Conclusion: Based on worldwide data, esophageal cancer development following bariatric surgery has increased over the past decades. Treatment of patients with esophageal cancer after bariatric surgery is challenging and requires a highly individualized approach in which optimal treatment and anatomical limitations are carefully balanced. Graphical abstract: [Figure not available: see fulltext.]
Original languageEnglish
Pages (from-to)4954-4962
Number of pages9
JournalObesity Surgery
Issue number11
Early online date2021
Publication statusPublished - Nov 2021


  • Bariatric surgery
  • Esophageal cancer
  • Esophagectomy
  • Treatment

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